Assisted Reproductive Technology Management and Reproductive Outcomes in Women with Severe Uterine Factor Infertility: A Retrospective Case Series

Background/Objectives: To describe clinical phenotypes, assisted reproductive technology (ART) laboratory findings, management pathways, and patient-level reproductive outcomes in women with severe uterine factor infertility managed at a public tertiary referral hospital in Viet Nam. Methods: This retrospective case series included patients with severe uterine factor infertility who underwent ART management between January 2020 and December 2025. Outcomes were reported at the patient level and stratified by management pathway: self-uterine embryo transfer, defined as embryo transfer into the patient’s own uterus, or gestational surrogacy. Descriptive statistics were used. Results: Fourteen patients were included in the descriptive cohort, and 13 were included in the pathway/outcome analysis. Nine patients (64.3%) had an absent or nonfunctional uterus, and five (35.7%) had major congenital uterine anomalies with potential for self-uterine embryo transfer. Median ART laboratory outcomes were 11 retrieved oocytes, 9.5 oocytes used for intracytoplasmic sperm injection, 9 fertilized oocytes, and 4 blastocysts. In the pathway/outcome cohort, five patients were managed through the self-uterine pathway and eight through gestational surrogacy, leading to a total of 11/13 patients (84.6%) who underwent at least one embryo transfer. Clinical pregnancy occurred in 8/13 patients (61.5%), resulting in five live births, two pregnancy losses after ongoing pregnancy, and one ongoing pregnancy at data cutoff. Conclusions: Severe uterine factor infertility required individualized, pathway-specific reproductive management. Patient-level reporting by management pathway and embryo transfer exposure provided a description of outcomes in this rare patient group, including in a setting where gestational surrogacy for humanitarian purposes is restricted to authorized hospitals and ART centers.